What do we know about written assessment of health professionals’ communication skills? A scoping review

ObjectiveThe aim of this scoping review was to investigate the published literature on written assessment of communication skills in health professionals’ education.MethodsPubmed, Embase, Cinahl and Psychnfo were screened for the period 1/1995–7/2020. Selection was conducted by four pairs of reviewers. Four reviewers extracted and analyzed the data regarding study, instrument, item, and psychometric characteristics.ResultsFrom 20,456 assessed abstracts, 74 articles were included which described 70 different instruments. Two thirds of the studies used written assessment to measure training effects, the others focused on the development/validation of the instrument. Instruments were usually developed by the authors, often with little mention of the test development criteria. The type of knowledge assessed was rarely specified. Most instruments included clinical vignettes. Instrument properties and psychometric characteristics were seldom reported.ConclusionThere are a number of written assessments available in the literature. However, the reporting of the development and psychometric properties of these instruments is often incomplete. Practice implications written assessment of communication skills is widely used in health professions education. Improvement in the reporting of instrument development, items and psychometrics may help communication skills teachers better identify when, how and for whom written assessment of communication should be used.     

Health professionals’ view on the role of hope and communication challenges with patients in palliative care: A systematic narrative review

ObjectiveTo identify health professionals' (HPs) perspectives on the role of hope and the main challenges faced when communicating with patients in palliative care (PC).MethodsSearch on PubMed, Scopus, SocIndex, Cochrane, and Web of Science using: palliat*, palliative care, palliative medicine, hospice care, terminal care, long term care, supportive care, end of life (EOL) care and hope*, followed by a thematic narrative analysis.ResultsThirty-five studies were included. HPs' views were grouped in: Bringing out hope and Taking down hope. HPs believe that hope is elicited through a personal patient-provider bond and exhibited through medical treatment delivery. HPs face difficulties when delivering prognosis, referring to hospice, and providing palliation.ConclusionHope is conveyed through verbal and non-verbal communication. HPs struggle to account for hope's shifting character, challenging the engagement in EOL discussions.Practical implicationsFindings show a patient-provider clash of perspectives, suggesting a gap in acknowledging the shifting nature of hope. An important question emerges: Are the existing theories of hope that are solely explained from a patient experience relevant for HPs' own interpretation? Investigating the HPs' attitudes gathered in collective experiences in PC, might contribute to answering the question in the context of building more constructive communication approaches.     

Internet of things-based health monitoring system for early detection of cardiovascular events during COVID-19 pandemic

The coronavirus disease 2019 (COVID-19) has currently caused the mortality of millions of people around the world. Aside from the direct mortality from the COVID-19, the indirect effects of the pandemic have also led to an increase in the mortality rate of other non-COVID patients. Evidence indicates that novel COVID-19 pandemic has caused an inflation in acute cardiovascular mortality, which did not relate to COVID-19 infection. It has in fact increased the risk of death in cardiovascular disease (CVD) patients. For this purpose, it is dramatically inevitable to monitor CVD patients’ vital signs and to detect abnormal events before the occurrence of any critical conditions resulted in death. Internet of things (IoT) and health monitoring sensors have improved the medical care systems by enabling latency-sensitive surveillance and computing of large amounts of patients’ data. The major challenge being faced currently in this problem is its limited scalability and late detection of cardiovascular events in IoT-based computing environments. To this end, this paper proposes a novel framework to early detection of cardiovascular events based on a deep learning architecture in IoT environments. Experimental results showed that the proposed method was able to detect cardiovascular events with better performance (95.30% average sensitivity and 95.94% mean prediction values).     

The intracorrelation of family health insurance and job lock

This paper tests for the presence of job lock and “health insurance plan lock” stemming from the health shock of a child family member. Using the onset of an acute, unanticipated health shock, I estimate a 7–14 percent decreased likelihood of all family members leaving their current health insurance network and health plan within one year of the emergency. This corresponds to a reduced one-year job mobility rate of approximately 13 percent for the health plan’s primary policyholder. Furthermore, the non-portability of health insurance products may contribute to the observed job and health plan lock.     

T1~T2期乳腺癌保乳术后化疗后程同步大分割放疗前瞻性Ⅰ期临床研究

目的 前瞻性评估T1~T2期乳腺癌保乳术后化疗后程大分割放疗的不良反应和耐受性，以及在缩短治疗时间、减轻患者经济负担等方面的价值。方法 共入组20例T1~T2期乳腺癌保乳术后患者，所有患者于末次多西他赛化疗前开始大分割放疗。观察急性放射反应、治疗完成率及无病生存率、住院时间及住院费用等。结果 治疗完成率100%。主要不良反应为血液学毒性（白细胞减少）及皮肤反应，患者均可耐受。中位随访时间为30.1个月，随访率100%。美容效果良好率100%。平均总治疗时间为4周，总住院治疗费用节省约1万元。21个月无病生存率为100%。结论 T1~T2期乳腺癌保乳术后可耐受同步大分割放化疗，局部控制好，美容效果佳，且具有较高的卫生经济学价值。     

The impact of neighborhoods and friendships on interracial anxiety among medical students and residents: A report from the medical student CHANGES study

Objective

To examine the experience of interracial anxiety among health professionals and how it may affect the quality of their interactions with patients from racially marginalized populations. We explored the influence of prior interracial exposure—specifically through childhood neighborhoods, college student bodies, and friend groups—on interracial anxiety among medical students and residents. We also examined whether levels of interracial anxiety change from medical school through residency.

Data Source

Web-based longitudinal survey data from the Medical Student Cognitive Habits and Growth Evaluation Study.

Study Design

We used a retrospective longitudinal design with four observations for each trainee. The study population consisted of non-Black US medical trainees surveyed in their 1st and 4th years of medical school and 2nd and 3rd years of residency. Mixed effects longitudinal models were used to assess predictors of interracial anxiety and assess changes in interracial anxiety scores over time.

Principal Findings

In total, 3155 non-Black medical trainees were followed for 7 years. Seventy-eight percent grew up in predominantly White neighborhoods. Living in predominantly White neighborhoods and having less racially diverse friends were associated with higher levels of interracial anxiety among medical trainees. Trainees' interracial anxiety scores did not substantially change over time; interracial anxiety was highest in the 1st year of medical school, lowest in the 4th year, and increased slightly during residency.

Conclusions

Neighborhood and friend group composition had independent effects on interracial anxiety, indicating that premedical racial socialization may affect medical trainees' preparedness to interact effectively with diverse patient populations. Additionally, the lack of substantial change in interracial anxiety throughout medical training suggests the importance of providing curricular tools and structure (e.g., instituting interracial cooperative learning activities) to foster the development of healthy interracial relationships.     

Characterizing Standardized Functional Data at Inpatient Rehabilitation Facilities

ObjectiveThe Improving Medicare Post-Acute Care Transformation Act of 2014 mandates using standardized patient functional data across post-acute settings. This study characterized similarities and differences in clinician-observed scores of self-care and transfer items for the standardized section GG functional domain and the functional independent measure (FIM) at inpatient rehabilitation facilities.DesignWe conducted secondary analyses of 2017 Uniform Data System for Medical Rehabilitation national data. Patients were assessed by clinicians on both section GG and FIM at admission and discharge. We identified 7 self-care items and 6 transfer items in section GG conceptually equivalent with FIM. Clinician-assessed scores for each pair of items were examined using score distributions, Bland-Altman plot, correlation (Pearson coefficients), and agreement (kappa and weighted kappa) analyses.Setting and ParticipantsIn all, 408,491 patients were admitted to Uniform Data System for Medical Rehabilitation-affiliated inpatient rehabilitation facilities with one of the following impairments: stroke, brain dysfunction, neurologic condition, orthopedic disorders, and debility.MeasuresSection GG and FIM.ResultsPatients were scored as more functionally independent in section GG compared with FIM, but change score distributions and score orders within impairment groups were similar. Total scores in section GG had strong positive correlations (self-care: r = 0.87 and 0.95; transfer: r = 0.82 and 0.90 at admission and discharge, respectively) with total FIM scores. Weak to moderate ranking agreements with total FIM scores were observed (self-care: kappa = 0.49 and 0.60; transfers: kappa = 0.43 and 0.52 at admission and discharge, respectively). Lower agreements were observed for less able patients at admission and for higher ability patients of their change scores.Conclusions and ImplicationsOverall, response patterns were similar in section GG and FIM across impairments. However, variations exist in score distributions and ranking agreement. Future research should examine the use of GG codes to maintain effective care, outcomes, and unbiased reimbursement across post-acute settings.     

Assessment of the knowledge,attitudes, and practices among UNRWA health staff in Jordan concerning mental health programme pre-implementation: a cross-sectional study

Background

Mental health is a major public health priority, particularly among refugees worldwide. The United Nations Relief and Works Agency for Palestine Refugees (UNRWA) started to integrate mental health and psychosocial support (MHPSS) into its primary health-care services in Jordan in late 2017. This baseline study aimed to assess the knowledge, attitudes, practices, and perceived barriers among UNRWA health staff regarding the implementation of the MHPSS programme.

基层医疗卫生服务整合的国际经验及对我国的启示

目的:总结典型国家基层卫生服务提供中实现医防整合的经验,为我国基层医疗卫生服务整合提供借鉴。方法:本研究方法为文献研究。结果:在个人层面,英国、泰国、古巴培养全科医生作为"守门人"并将其作为提供医防整合服务的主体;在机构层面,各国基层机构组成服务网络,内部强调跨学科合作;在体系层面,通过横向合作和有序的首诊与转诊协调服务;国家立法保障和健康保险筹资等引导支持基层医疗卫生服务整合。结论:培养和配置高质量的医防一体的全科医生、促进机构跨学科融合、通过立法和筹资体系予以保障是各国提供基层整合型服务的核心,值得我国基层医防服务整合借鉴。